Study: Best practices not always best for all

When physicians don't follow uniform guidelines, it may be because patients aren't uniform.

By Andis Robeznieks, AMNews staff. Dec. 3, 2001.

A recent study found a 24% noncompliance rate in the use of best practice procedures by physicians treating patients with type 2 diabetes, but researchers say this result does not represent a deficiency in care but, instead, a deficiency in the definition of what constitutes best practices.

"When people see the study, they think 'Oh, those bad doctors, why don't they do what they're supposed to do?' " said Vincenza Snow, MD, a Wayne, Pa., internist and a co-author of the study published in the September/October issue of Effective Clinical Practice. Dr. Snow added that this was a notion the study attempted to refute.

"Physicians remember the guidelines, are familiar with them and they try their hardest to apply them, but sometimes they can't," Dr. Snow said. "Their patients are not part of the population to which these guidelines apply."

Research used to formulate evidence-based, best practice guidelines often includes subjects who are younger and healthier, she said, but the patients physicians actually see are older and sicker, and the long-term preventative strategies best practices are based on may not be applicable to the patient's immediate needs.

Dr. Snow and her co-authors analyzed the treatment of 1,755 diabetics by 85 internists who volunteered for the study. About 70% of the physicians were in group practice with at least two other doctors, while 30% either practiced solo or with only one other physician.

The internists, who averaged 21 years in practice, were asked if the treatment of their diabetic patients included the following best practice procedures: [...]